Antidepressants

Question 1

Which NTs are affected in depression and how?

Answer 1

Too little CNS NE and/or 5HT

Question 2

What is the major mystery of antidepressant therapy in terms of timing?

Answer 2

• pharmacologic effect happens instantly, but clinical improvement can take weeks or months to occur (due to receptor regulation?)

Question 3

What is the action of MAOa? MAOb?

Answer 3

MAOa - oxidizes NE, 5HT, tyramine

MAOb - oxidizes DA, phenyethylamine

Question 4

When treating depression with MAOI’s, which MAO type is irreversibly inhibited?

Answer 4

Both MAOa and MAOb

Question 5

When on psych rotation, your attending asks you which MAOIs you have learned. Your response:

Answer 5

tranylcypromine, phenelzine

Question 6

What is an important side effect of MAOI’s?

Answer 6

May lead to hypertensive crisis if tyramine-rich food is eaten

Question 7

How do tricyclic antidepressants work?

Answer 7

• block reuptake of NE or 5HT

- can also block muscarinic, a-adrenergic, dopamine, and histamine receptors (which give unwanted side effects)

Question 8

The tricyclics are rarely used for mental health issues anymore because of their side effects and the development of new and improved drugs. What else are tricyclics used for?

Answer 8

sleep, chronic pain, enuresis, migraines

Question 9

Rapid fire: name the four tricyclics

Answer 9

• desipramine
• imipramine
• amitriptyline
• nortriptyline

Question 10

What are the main differences between SSRI’s and tricyclics?

Answer 10

• SSRI’s have: longer duration of action, inhibition of P450 enzymes, more safety in OD, fewer side effects, but more nausea and complaints of decreased sexual function

Question 11

Which SSRI can be used to treat premenstrual dystrophic disorder?

Answer 11

fluoxetine

Question 12

Name the 5 SSRI’s. What are they used to treat?

Answer 12

fluoxetine, paroxetine, sertraline, escitalopram, citalopram

• used for depression, anxiety, PTSD, chronic pain, enuresis, bulimia, alcoholism

Question 13

What dangerous drug interaction can occur with SSRI + MAOI and what are the symptoms?

Answer 13

• serotonin syndrome

- hyperthermia, muscle rigidity, myoclonus, rapid changes in mental status (potentially lethal)

Question 14

What are the two SNRI’s?

Answer 14

duloxetine, venlafaxine

Question 15

How does bupropion work? Major side effect?

Answer 15

• blocks DA and NE reuptake
• can also have some effect on nicotinic receptors and helps maintain nicotine abstinence while smokers are trying to quit
• SE: lowers seizure threshold!

Question 16

How does mirtazapine work?

Answer 16

• 5HT2a antagonist, and also inhibits 5HT reuptake

Question 17

What mood stabilizing agent can be used to treat bipolar disorder and what is its MOA?

Answer 17

• lithium

- MOA unknown but depletes secondary messengers IP3 and DAG

Question 18

What anticonvulsants may be effective in treating some bipolar patients?

Answer 18

• carbamazepine, valproate